People with mental illnesses are twice as likely to smoke cigarettes as other people and consume nearly half of all cigarettes smoked in the United States, a new study says.
　　
　　The Harvard University and Smith College research, published in the latest issue of the Journal of the American Medical Association, suggests a need to target smoking prevention strategies for the mentally ill, an especially vulnerable population.
　　
　　The study found that 41 percent of all mentally ill people smoked cigarettes, compared to 22.5 percent of people who had never been mentally ill. Patients with more severe mental illnesses, such as schizophrenia and depression, had the highest likelihood of smoking heavily, says study author Dr. Karen Lasser of the Harvard School of Public Health in Cambridge, Mass. Lasser is a postdoctoral student in the school of public health and a physician.
　　
　　The findings are based on data from 4,411 respondents aged 15 to 54 years old in an 1991 and 1992 congressionally mandated survey of psychiatric illness. The information in the survey has the latest available data about mental illness and smoking.
　　
　　 Lasser says the results confirm what health-care workers observe daily in psychiatric facilities  that many of the patients smoke. She says she hopes such quantifiable data on the number of mentally ill Americans who smoke will help public health policy makers to target smoking cessation programs and funds for the mentally ill.

Tobacco Part of Psychiatric Culture

Experts say mentally ill people smoke so much because tobacco has become part of the culture of mental health facilities.
　　
　　"Institutions, especially state-run, have used tobacco as a reward [for mentally ill patients],"explains Dr. John Bachman, a clinical psychologist and nicotine dependency researcher in Menlo Park, Calif. “Management has said it won’t be responsible for depriving them of the few pleasures they have left."br /> 　　
　　Smoking rates among the mentally ill are higher because there is not much social and cultural stimulation in their lives, he adds, asking, “What does lung cancer in 20 years mean to a hallucinating patient now?"br /> 　　
　　Bachman says nicotine has a dual effect "both soothing and stimulating, depending on what state of body or mind the smoker is in. Psychiatric patients tend to be on medications that can dull them, so they often use cigarettes to stimulate themselves out of a drug-induced stupor, he says.

Nicotine Replacement Therapy

Although the mentally ill may be a difficult population to wean off cigarettes, new treatments, such as nicotine patches, are now available to help them.
　　
　　Using nicotine patches or gum, so that patients continue to get the stimulation they seek without the health risks of smoking, may be especially effective in helping mentally ill smokers quit, says Dr. Jack Henningfield, an associate professor of psychiatry at John Hopkins University Medical School in Baltimore, Md., and contributor to several U.S. Surgeon General reports on tobacco cessation.
　　
　　"A decade or two ago we didn’t have anything to offer [the mentally ill], but now we are on safer footing,"he says.
　　
　　But since cigarette smoke makes the body metabolize medication more quickly, smoking cessation for the mentally ill must be monitored by a health professional so drug doses are adjusted accordingly, adds Hennigfield. Smoking cessation programs for the mentally ill should include both medication and therapy, he says.
　　
　　The study found that 37 percent of mentally ill smokers successfully managed to kick the habit, as compared to 42.5 percent for people with no history of mental illness, suggesting that targeted smoking cessation programs could be effective.
　　
　　Lasser says raising cigarette taxes could serves as a smoking deterrent for the mentally ill because they tend to have a lower income level. Tax revenues could then be used to fund smoking cessation and other programs for mental illness and to support counter advertising campaigns.

Big Tobacco Targets Vulnerable

There have been no studies that have examined the effect of cigarette advertisements on the mentally ill. But Lasser says the tobacco industry targets psychologically vulnerable people as part of their market. In her study, she cited internal marketing documents from the R.J. Reynolds Tobacco Company, in Winston-Salem, North Carolina, describing smokers who smoke for “mood enhancement"and “positive stimulation."br /> 　　
　　"The marketing study implied that smokers used nicotine for depressive symptoms, stating that smoking ‘helps perk you up"and ‘helps you think out problems,’"the study reports.
　　
　　R.J. Reynolds spokeswoman Carole Crossler declined to comment, saying the company had not had an opportunity to review the study. Spokespeople for Phillip Morris, headquartered in New York City, also declined to comment.

Sensation-Seeking Smokers

Nov. 21 "People who thrive on the burst of adrenaline that comes from a roller coaster ride or skydiving may be more likely to smoke than those who seek solitude and calm, suggests another smoking study.
　　
　　According to the report in the November issue of Experimental and Clinical Psychopharmacology, these people "known as sensation seekers "experience more intense feelings from nicotine than those without this personality trait.
　　
　　"Sensation seeking may be related to risk of becoming a smoker because these people experience greater positive as well as adverse effects from nicotine,"says Dr. Kenneth A. Perkins, the study’s lead author. “This leads them to try smoking again and again."

Perkins says that over time, these people become tolerant to the adverse effects of nicotine and may be able to tolerate higher doses.
　　
　　Study results might help to develop programs that target teens who smoke, the researchers suggest.
　　
　　Perkins, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues determined sensation-seeking elements of personality through a questionnaire. The investigators measured physiological responses to nicotine, such as heart rate and blood pressure, after individuals used a nasal nicotine spray at varying doses on three occasions.
　　
　　The study participants, including 37 nonsmokers and 55 smokers aged 21 to 40 years.

(From ABCNews)